Cervical Carcinoma in Situ

Overview

The cervix is the bottom of your uterus (where a baby grows during pregnancy). It resembles a doughnut and links your uterus to the entrance of your vagina. It is coated in cell-based tissues. These healthy cells are what can develop into precancer cells.

Carcinoma in situ (CIS) refers to a collection of abnormal cells. While they are a kind of neoplasm, it is debatable whether CIS should be categorized as cancer. This debate is also dependent on the specific CIS in question (i.e., cervical, skin, breast).

Some writers, however, do not define them as cancer, understanding that they have the potential to develop cancer. Others categorize certain kinds of cancer as non-invasive. The phrase "pre-cancer" has been used.

These aberrant cells develop in their place, therefore called "in situ" (from Latin for "in its place"). For example, skin carcinoma in situ, commonly known as Bowen's disease, is the buildup of dysplastic epidermal cells exclusively in the epidermis that have not penetrated into the deeper dermis. As a result, CIS seldom develops into a tumor. Rather, the lesion is flat (in the skin, cervix, etc.) or follows the organ's existing architecture (in the breast, lung, etc.).

Many types of CIS have a high risk of developing into cancer, therefore removal may be advised; nonetheless, CIS development is known to be very variable, and not all CIS develops into invasive malignancy.

What is Carcinoma in Situ of the cervix?

Carcinoma in situ (CIS) refers to an early-stage malignancy. Cervical cancer in situ is also known as stage 0 cervical cancer. It is non-invasive, which indicates that the malignant cells are restricted to the surface of your cervix and have not infiltrated further into the tissues.

The cervix is the uterus's small, bottom section. It's the tube that connects the uterus to the vaginal canal. Cervical cancer develops on the cervix's surface and grows slowly. It is caused by numerous strains of the human papillomavirus (HPV) virus, which is transmitted through sexual intercourse.

According to the Centers for Disease Control and Prevention (CDC), over 12,000 women were diagnosed with cervical cancer in the United States in 2012. The majority of these ladies were under the age of 55. Cervical cancer is uncommon in women under the age of 20. It was formerly the greatest cause of cancer in women, but cases have declined in the last 40 years.

Cervical intraepithelial neoplasia (or CIN) is a term that currently refers to all cervix epithelial abnormalities. The epithelial cells are cancerous, but they are limited to the epithelium. The previous nomenclature of dysplasia and CIS implies a two-tier disease process that has affected therapy in the past—that is, if just dysplasia was present, no or minimal treatment was required.

What are the symptoms of Cervical Carcinoma in Situ?

Cervical cell precancerous alterations seldom generate symptoms. A cervical screening test is the only method to find out whether there are any abnormal cells that might develop into cancer. If early cell alterations progress to cervical cancer, the following are the most typical symptoms:

Vaginal bleeding between periods
Menstrual bleeding that is longer or heavier than usual
Pain during intercourse
Bleeding after intercourse
Pelvic pain
A change in your vaginal discharge, such as more discharge or with a strong or strange color or odor
Vaginal bleeding after menopause.

Other disorders might produce these symptoms, but if you are concerned or your symptoms continue, consult your doctor. This is critical for anybody who has a cervix, whether straight, lesbian, gay, bisexual, or transgender.

What are the risk factors of Cervical Carcinoma in Situ?

The biggest risk factor for developing cervical CIS is HPV. There are hundreds of HPV strains, which are classified as low or high risk. There are ten high-risk strains linked with aberrant cell changes in the cervix that can lead to cancer, although two of the strains (HPV 16 and HPV 18) account for 70% of cervical cancer incidences.

HPV is a sexually transmitted virus. HPV is transmitted by sexual contact (anal, oral, or vaginal) and can cause cancer. The majority of people will get HPV at some time in their life and be unaware of it because their bodies fight the illness. However, if your body does not fight the infection, the cells in your cervix might become malignant.

Early identification of HPV is critical in the prevention of cervical cancer. Regular checkups with your doctor can help detect cell changes before they become cancerous. By protecting you against the HPV that causes up to 90% of all cervical malignancies, the HPV vaccination can help prevent HPV infection.

Other risk factors that may contribute to the development of cervical CIS include:

Screening history: Those who have not had Pap tests at regular intervals are at a higher risk of developing cervical cancer.
Sexual history: Having sexual intercourse before the age of 18 and having many sexual partners puts you at higher risk of HPV infection and chlamydia. Preventing these diseases reduces your risk of cervical cancer.
HIV infection: Those who've been infected with HIV have a higher-than-average risk of developing cervical cancer.
Having multiple sexual partners.
Multiple children: Having three or more full-term pregnancies may raise your chances of acquiring cervical cancer.
Smoking: Cigarette smoking is associated with an increased risk of cervical cancer.
Immunodeficiency: Having a weak immune system makes your body unable to fight infections.
Having a diet low in fruits and vegetables.
Birth control pills: There is evidence that long-term use of oral contraceptives can increase your risk of cervical cancer.
Being infected with chlamydia.
DES (diethylstilbestrol): DES is a hormone medication that was used to prevent miscarriage between 1938 and 1971. You are more likely to get cervical cancer if your mother used DES.
Cervical cancer may have a genetic component.

How is Cervical CIS Diagnosed?

Classification of cervical precancerous conditions

CIN (Cervical Intraepithelial Neoplasia) is a term used to describe the state of the cervix in which dysplastic cells replace a portion or the entire thickness of stratified squamous epithelial cells.

Different nomenclature was used in this system for cytologic (on Pap test) and histologic (on biopsy) results. The term "squamous intraepithelial lesion (SIL)" was used to describe cytologic abnormalities, while "cervical intraepithelial neoplasia" was used to describe histologic alterations (CIN).

CIN I: low-grade lesion with mildly atypical cellular change in the lower third of the epithelium.
CIN II: high-grade lesion with moderately atypical cellular changes confined to basal two-thirds of epithelium.
CIN III: severely atypical cellular changes encompassing greater than two-thirds of the epithelial thickness and includes full-thickness lesions (severe dysplasia or carcinoma in situ, CIS).

Colposcopy with biopsy

If your screening test results indicate that you have signs of cervical CIN, you will be sent to a specialist for further testing.

A colposcopy determines the location and appearance of abnormal cells in the cervix. A speculum is put into your vagina so that the doctor may inspect the cervix and vagina using a colposcope, which is a magnifying equipment similar to binoculars. It is placed close to your vulva but not inside your body. A colposcopist, who is generally a gynecologist or, in certain clinics, a nurse practitioner, performs the operation.

If the colposcopist notices anything unusual, they will generally extract a tissue sample (biopsy) from the cervix's surface for evaluation under a microscope by a pathologist.

Large loop excision of the transformation zone (LLETZ) or cone biopsy

If any of the tests reveal precancerous cell alterations, you may require a big loop excision or a cone biopsy.

LLETZ is the most often used procedure for removing cervical tissue for inspection and treatment of precancerous cervix alterations. It is often performed under a local anesthesia.

A cone biopsy is performed when aberrant glandular cells are found in the cervix or when early-stage cancer is suspected.

Cervical carcinoma in situ treatment

Cervical CIS is treated in the same way as cervical dysplasia is. Because it is not invasive, carcinoma in situ is frequently treated as a precancerous growth.

Possible treatments include the following:

A hysterectomy is an option for women who don’t want to preserve their fertility.
Cryosurgery.
Laser surgery or loop electrosurgical excision procedure.
Conization.

Discuss your treatment choices with your doctor to determine which is best for you. Your therapy will be determined by your age, desire to maintain fertility, general health, and other risk factors.

Cryosurgery

Cryotherapy is performed while you are awake at your doctor's office. You may experience little cramps. During the procedure, you may experience some pain.

To perform the procedure:

A tool is placed into the vagina to keep the walls open so the doctor can see the cervix.
The doctor then inserts a cryoprobe into the vagina. The device is securely put on the cervix's surface, covering the aberrant tissue.
Compressed nitrogen gas travels through the device, freezing the metal and destroying the tissue.

An ice ball develops on the cervix, killing the aberrant cells. For the therapy to be most effective:

The freezing is done for 3 minutes.
The cervix is allowed to thaw for 5 minutes.
Freezing is repeated for another 3 minutes.

Loop electrosurgical excision procedure

A loop electrosurgical excision procedure (LEEP) removes aberrant tissue from the cervix by heating a loop of thin wire with electricity. To remove the tissue, the wire loop serves as a scalpel.

During LEEP, you will be laying on your back with your feet raised in stirrups. The doctor will insert a speculum into the vagina to keep it open. Local freezing will be used to numb your cervix, and you may be given pain medication orally or intravenously.

The doctor examines the vagina and cervix with a colposcope and guides the wire loop to the tissue in the cervix. Heat is used by the wire loop to destroy the aberrant cervical tissue. You may hear some noise from the equipment linked to the wire loop during a LEEP.

Endocervical curettage may be performed concurrently with LEEP. To remove cells from the endocervical canal, a brush or an instrument known as a curette is used. After that, the cervical tissue and cell samples are transported to a lab to be examined under a microscope.

Most women are able to resume most of their routine activities within 1 to 3 days after LEEP. You will be instructed to abstain from sexual activity, douching, and the use of tampons for 3 to 4 weeks.

A Pap test will be performed every 4 to 6 months. After a few normal Pap test results, you and your doctor will decide how frequently you should get the test. If there is still illness after the initial operation, there is a slight chance that LEEP will need to be repeated.

Conization

A cold knife cone biopsy is a surgical operation performed to remove cervix tissue. The cervix is a thin section of the lower end of the uterus that ends in the vagina. Conization is another term for a cold knife cone biopsy. A big cone-shaped section of the cervix is removed during this treatment to search for precancerous cells or cancerous material.

The cold knife cone biopsy procedure takes less than an hour. Like a routine gynecological checkup, you'll lie on an examining table with your feet in stirrups. Your doctor will introduce a speculum into your vagina to press the vaginal walls apart and maintain your vagina open for the biopsy. Your doctor will perform the biopsy after you have been anesthetized with either regional or general anesthesia.

A cone-shaped portion of cervical tissue will be removed by your doctor using either a surgical knife or a laser. To reduce cervical bleeding, your doctor will utilize one of two methods. To stop the bleeding, they may cauterize the region with an instrument that plugs the blood arteries. They may also sew traditional surgical sutures onto your cervix.

The cervical tissue that was taken will be analyzed under a microscope to identify the presence of malignancy. Your doctor will contact you as soon as the findings are available.

Outpatient cold knife cone biopsies are most commonly done. Within a few hours, the anesthetic wears off. You can leave the same day.

Follow-Up Care for Cervical CIS

Following treatment for cervical CIS, your doctor will want to see you every three to six months for follow-up appointments and Pap screenings. Cervical CIS can reoccur, but frequent Pap screens and examinations can enable your doctor to detect and treat suspicious cells at an early stage.

In addition, your doctor will address any concerns you have regarding your cervical health.

Cervical CIS may be emotionally exhausting, especially if you're worried about your fertility. If you want further assistance, speak with your doctor about joining a support group or hiring a counselor.

Cervical carcinoma in situ Prognosis

A 2004 study calculated the 45-year survival of 12,655 individuals diagnosed with carcinoma in situ lesions between 1953 and 2000 and submitted. There was a 1% decline in cumulative relative survival each 5 years of follow-up up to 30 years. After that, the excess mortality rose, and after 45 years, the survival rate was 84%.

The 15-year survival rate was 100% in individuals under 30 at the time of diagnosis and decreased with age. Patients aged 60 to 74 had an 89% chance of survival. Women with carcinoma in situ had a significantly higher risk of mortality (>10%) exclusively at advanced ages, regardless of the age of diagnosis.

Cervical cancer prevention

There are some things you can do to protect yourself from cervical cancer. The most important steps toward preventing cervical cancer are regular gynecological exams and Pap tests. You can also perform the following:

Get the HPV vaccine (if you are eligible).
Use condoms or other barrier methods when you have sex.
Limit your sexual partners.
Stop smoking and using tobacco products.

Unfortunately, despite significant declines in fatalities from squamous cell cervix cancer, there has been no discernible reduction in adenocarcinoma mortality in most places with well-established cervical screening programs.

One of the reasons for this is the cervical cytology screening procedure. It is done for squamous cell alterations but may miss cervical glandular cell changes. Also, keep in mind that these screening tests are not 100% accurate in detecting abnormal cells. This fact alone emphasizes the importance of visiting your gynecologist on a regular basis.

Cervical cancer screening

The Pap test and the HPV test are used to identify cervical cancer. These cervical cancer tests can detect abnormal or troublesome cells in their early stages, before they can develop into cancer. Cervical cancer is extremely curable and less likely to progress if these cells are discovered early.

Your healthcare professional collects cells for Pap and HPV testing by swabbing or scraping your cervix with a brush. You lie on an exam table, your feet in stirrups. A speculum is placed in your vagina (this opens up your vagina). The cells are placed in a liquid and sent to a lab for testing after the swab is taken.

Cervical cancer screening seeks to detect cell abnormalities in your cervix before they progress to cancer. Since women have begun having regular cervical cancer screenings, the number of cases and fatalities from the disease has declined dramatically in the United States.

Pap test: This test detects abnormal or irregular cells in your cervix.
HPV test: This test detects the high-risk types of HPV infection that are most likely to cause cervical cancer.

Your doctor may advise you to have a Pap test and an HPV test. This is known as co-testing, and it may be a possibility for you if you are above the age of 30.

The majority of people should have frequent cervical cancer tests. Screenings include Pap tests, HPV testing, or a combination of the two.

These are the cervical screening cancer guidelines:

Regardless of sexual history, cervical cancer screening should begin at the age of 21. Some healthcare practitioners are willing to postpone this till the patient is 25 years old.
Screening with just a Pap test is advised every three years for adults aged 21 to 29. (No HPV test).
Co-testing with Pap and HPV should be done every five years for persons aged 30 and up, or Pap testing alone every three years.
Routine Pap tests should be ceased in women who have had a complete hysterectomy for benign reasons and have no history of CIN (cervical intraepithelial neoplasia) grade 2 or above.
Cervical cancer screening can be stopped at the age of 65 if you have had two consecutive normal co-test results or three consecutive normal Pap test results in the previous ten years, with the most recent normal test completed within the last five years.
People who have had sufficient treatment for CIN grade 2 or above must continue screening for 20 years, even if they are over the age of 65.
People aged 65 to 70 who have had three or more normal Pap tests in a row and no abnormal Pap test results in the previous 20 years should discontinue cervical cancer screening. Those who have a history of cervical cancer, DES exposure before to birth, HIV infection, or a compromised immune system should continue to be screened as long as they are healthy.
Those who have undergone a total hysterectomy (removal of the uterus and cervix) should discontinue cervical cancer screening as well, unless they have a history of cervical cancer or precancer. People who have undergone a hysterectomy without having their cervix removed should continue to follow the rules outlined above.

Those who have particular risk factors, such as prenatal DES exposure, HIV infection, or a weaker immune system, will follow a modified protocol.

Human papilloma virus (HPV) vaccine

The HPV vaccination, which protects against the development of cervical cancer, is licensed for children and adults aged 9 to 26. The vaccination works by stimulating your immune system to target specific strains of human papillomavirus (HPV), which have been related to many incidences of cervical cancer. It is preferable to acquire the immunization before beginning sexual activity. The vaccination is administered in a series. The number of injections required vary based on your age at the time of your first dosage.

Conclusion

You may feel shocked, scared, disturbed, or confused after discovering you have cervical CIN. All of these are normal reactions. Everyone responds differently, and there is no right or wrong way to feel. It may be beneficial to discuss your feelings with family and friends. Discuss your treatment choices with your doctor and get as much information as you can.